Key result
Mexiletine treatment significantly reduced the total number of VT/VF episodes compared to a matched period before therapy initiation (33 vs 74 episodes, p=0.002).
Why the study?
Pharmacological therapy for ventricular arrhythmias when catheter ablation is unsuccessful or not feasible and conventional antiarrhythmic therapy with amiodarone and beta-blockers has failed or is contraindicated remains controversial.
Does mexiletine reduce VT/VF episodes in patients with ischaemic heart disease and refractory ventricular arrhythmias?
Cohort (n=34)
Does mexiletine reduce VT/VF episodes in patients with ischaemic heart disease and refractory ventricular arrhythmias?
Absolute Event Rate: 33% vs 74%
p-value: p=0.002
Mexiletine significantly reduces ventricular arrhythmias and ICD interventions in patients with ischemic heart disease and refractory VT/VF, though side effects requiring discontinuation are notable.
Mexiletine was associated with fewer VT/VF episodes; hypothesis-generating and requires randomized confirmation before practice change.
Background The pharmacological therapy of ventricular arrhythmias in patients with unsuccessful or not feasible catheter ablation and contraindication or inefficacy to amiodarone and beta-blockers, is controversial. The present study investigated the effectiveness and tolerability of mexiletine in patients with recurrent ventricular arrhythmias and ischaemic heart disease, when the conventional antiarrhythmic therapy failed.Methods We enrolled all consecutive patients with unsuccessful/not feasible catheter ablation and ineffective/contraindicated amiodarone or beta-blockers, which started the mexiletine treatment for refractory ventricular tachycardia (VT) or ventricular fibrillation (VF) between January 2010 and January 2020. The primary endpoint was the total number of VT/VF episodes after the beginning of mexiletine therapy. The 2 secondary endpoints were the overall number of therapies released by implantable cardioverter-defibrillators (ICDs) and the discontinuation of the pharmacological therapy. The events occurring during the mexiletine treatment period were compared with those observed in a matched duration interval before the initiation of therapy.Results Thirty-four consecutive patients (27 males, 79.4%; mean age 74.0 ± 9.5 years) with ischaemic heart disease were finally analysed. The median of mexiletine treatment was 26.5 months (interquartile range: 18.75–38.25 months). After the mexiletine start, VT/VF episodes and ICD interventions significantly decreased (respectively: 74 vs 33 episodes, p = 0.002; 116 vs 52 interventions, p = 0.02) in comparison with a matched period without mexiletine. Six patients (13.9%) discontinued the treatment because of severe side effects.Conclusions The treatment period following the mexiletine start was associated with a significant reduction of ventricular arrhythmias. The rate of side effects requiring dosage reduction or interruption was not neglectable.
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Mugnai et al. (2021) conducted a cohort in Refractory ventricular arrhythmias in ischaemic heart disease (n=34). Mexiletine vs. Matched duration interval before the initiation of therapy was evaluated on Total number of VT/VF episodes after the beginning of mexiletine therapy (p=0.002). Mexiletine treatment significantly reduced the total number of VT/VF episodes compared to a matched period before therapy initiation (33 vs 74 episodes, p=0.002).
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